Back pain in children is not like back pain in adults. Compared to
an adult, a child with a backache is more likely to have a serious underlying
disorder. This is especially true if the child is 4 years old or
younger, or if a child of any age has back pain accompanied by:

Fever or weight loss

Weakness or numbness

Trouble walking

Pain that radiates down one or both legs

Bowel or bladder problems

Pain that keeps the child from sleeping

More serious causes of back pain need early identification and treatment or they may
become worse. Always see a doctor if your young child's back pain lasts for more than
several days or progressively worsens.

Your spine is made up of small bones, called vertebrae, which are stacked on top of
one another and create the natural curves of your back.

Doctor Examination

Your doctor will begin by learning about how the problem developed, and then will
conduct a physical examination of your child.

Medical History

Your doctor will ask general questions about your child's overall health and more
specific questions about the pain. The questions and physical examination will allow
your doctor to determine which of a number of conditions is responsible for your child's
back pain.

Your doctor will want to know when the pain began, if it was associated with injury
or demanding activity, and whether it has improved or worsened. He or she will ask
whether there is anything that makes it worse, and what your child does to make it
less painful. It will be important for your doctor to know exactly where the pain
is felt, how severe it is, and how much it interferes with the child's schooling and
activities. If the pain shoots into a leg it could mean that there is pressure on
a nerve.

Physical Examination

The spine. Your doctor feels each vertebra and looks for deformities in the alignment and mobility
of the spine. Increased roundness of the back (when viewed from the side) or a curve
to the side (when viewed from the back) could be important. Your doctor will check
posture and walking gait, the ability to bend over to touch the toes, and bending
to the right and left. Difficulty with movement may indicate that there is a problem
with the joints of the spine.

Nerves in the back. Problems with the intervertebral disks can cause pressure on the nerves that exit
the spine, so your doctor will perform specific tests for that. With your child lying
face up, your doctor will raise the legs (straight leg raising test) and may also
raise the legs with your child lying face down (reverse straight leg raising test).
Testing reflexes and feeling in the legs will be done for the same reason.

Muscles. The muscles in the back and legs are tested. Tightness of the back muscles or the
hamstring muscles at the back of the thigh will show that your child is trying to
protect himself or herself from movements and positions that might be painful. Tenderness
of the muscles will indicate a muscle injury, such as a strain.

Balance, flexibility, coordination, and muscle strength. Other tests may be done to be sure the back pain is not part of a bigger picture.

Imaging Tests

The doctor may use one or several diagnostic imaging tools to see inside the body.

X-rays. X-rays of the spine will show the bones and may show fractures, displacements, or
other problems within the bones.

Bone scans. This test involves injecting a substance into a vein and then using a special camera
to see where it is picked up. It can pinpoint inflammation, infections, tumors, and
fractures. Since the anatomy of the spine is very complicated and since these disease
processes are not always visible on x-ray, the bone scan can be very useful.

Computed tomography (CT) scans. This is a special computerized x-ray technique that provides a three-dimensional
image and allows your doctor to see things that are not visible on two-dimensional
x-rays. It is particularly useful in the spine to understand the complex anatomy.

Magnetic resonance imaging (MRI). This technique is very valuable because it shows tissues other than bone. It can
be used to see the spinal cord, nerve roots, disks, or other soft tissues than can
be very important in back pain.

Positron emission tomography (PET). This test can be a useful adjunct by providing a three-dimensional image of functional
processes in the body.

Laboratory Tests

Blood tests, including the complete blood-cell count (CBC), erythrocyte sedimentation
rate (ESR), and C-reactive protein (CRP), can be affected by the presence of inflammation
or infection.

Muscle Strain and Imbalances

Musculoskeletal strain is most often responsible for back pain in children and adolescents.
This type of pain frequently responds to rest, anti-inflammatory medications, and
an exercise program.

Many teenagers may have more persistent back pain. This is often related to tight
hamstring muscles and weak abdominal muscles. These children seem to improve with
a physical therapy program that stresses hamstring stretching and abdominal strengthening.

Rounded Back

In adolescents, increased roundness of the back (when viewed from the side) — also
called Scheuermann's kyphosis — is a common cause of pain in the middle of the back
(the thoracic spine). Vertebrae become wedged, causing a rounded, or hunched, back.
The curved part of the back may ache and pain may get worse with activity.

An adolescent male presents with excessive roundback localized to
the thoracic spine. The severe kyphosis is most obvious when he bends forward.

Stress Fracture of the Spine

Spondylolysis, or stress fracture, may cause lower back pain in adolescents. Stress
fractures may occur during adolescent growth spurts or in sports that repeatedly twist
and hyperextend the spine, like gymnastics, diving, and football.

Pain is usually mild and may radiate to the buttocks and legs. The pain feels worse
with activity and better with rest. A child with spondylolysis may walk with a stiff
legged gait and only be able to take short steps.

Slipped Vertebra

In this drawing of spondylolisthesis, a lower back vertebra has shifted forward.

A slipped vertebra, or spondylolisthesis, occurs when one vertebra shifts forward
on the next vertebra directly below. This may sometimes represent progression of a
spondylolysis. It usually occurs at the base of the spine (lumbosacral junction).
In severe cases, the bone narrows the spinal canal, which presses on the nerves.

Infection

In young children, infection in a disk space (diskitis) can lead to back pain. Diskitis
typically affects children between the ages of 1 and 5 years, although older children
and teenagers can also be affected.

A child with diskitis may have the following symptoms.

Pain in the lower back or abdomen and stiffness of the spine

Walking with a limp, or simply refusing to walk

Squatting with a straight spine when reaching for something on the floor, rather than
bending from the waist

Tumor

On rare occasion, tumors, such as osteoid osteoma, can be responsible for back pain.
When they occur, tumors of the spine are most often found in the middle or lower back.
Pain is constant and usually becomes worse over time. This pain is progressive; it
is unrelated to activity and/or happens at night.

Reviewed by members of POSNA (Pediatric Orthopaedic Society of North America)

The Pediatric Orthopaedic Society of North America (POSNA) is a group of board eligible/board
certified orthopaedic surgeons who have specialized training in the care of children's
musculoskeletal health. One of our goals is to continue to be the authoritative source
for patients and families on children's orthopaedic conditions. Our Public Education
and Media Relations Committee works with the AAOS to develop, review, and update the
pediatric topics within OrthoInfo, so we ensure that patients, families and other
healthcare professionals have the latest information and practice guidelines at the
click of a link.

AAOS does not endorse any treatments, procedures, products, or physicians referenced
herein. This information is provided as an educational service and is not intended
to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance
should consult his or her orthopaedic surgeon, or locate one in your area through
the AAOS "Find an Orthopaedist" program on this website.